New anti-Cass screed

[Twawddle]

I stumbled across this tweet earlier today announcing a new critique of the Cass Review. It's by a couple of gender enthusiast clinicians who aren't best pleased with it:

My colleagues and I have been worried for some time about the way the Cass review has been reified into a kind of sacred text, when it's deeply flawed and infused with ideology. So I wrote a paper on it with Lorna Hobbs.

We are extremely grateful to the people who have inspired our writing, including @GidMK @RottenInDenmark @AlexAshman @Chican3ry @DadTrans and many others. As people involved in the transition from the old GiDs to the new, we're very concerned about the future.

That's why we write- we want a new government to take a new approach. So after a pretty long document, we close with some questions for @wesstreeting and his team. We would also love to work with @TheBMA on their critique of Cass.

Link to paper: https://docs.google.com/document/d/e/2PACX-1vQXUWs7GU9FX02LypDp9YltRfmtRVAAn9L9CIdKuuU2kHqz_z2BBttO3nJD4Wsau5EIHuHiapFCOTQ5/pub

Archive link: https://archive.today/D7Hys

All this has done has inspired me to write to Wes Streeting with a different opinion!

“Infused with ideology” is rich coming from genderists.

Well, erm... quite!

In committing these thoughts to print, we are not seeking to settle scores, or dismiss the work of the Cass review team. What we are aiming for is to convince the reader to approach the Cass review in a critical way, and to see it as a product of a particular world view and set of beliefs, rather than an authoritative objective overview

If they have to tell you some of the above stuff it's plausibly because the reader is likely to form a very different opinion when reading.

Max Davie's publication record is very limited so it's not the sort of basis I'd expect for decent critiques of how systematic reviews are conducted. Lorna Hobbs has some publication experience, including systematic reviews.

https://scholar.google.com/citations?user=T9WQUqcAAAAJ&hl=en&oi=ao

scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=lorna+hobbs+systematic+review&btnG=

This is a blog post but it's far from the language I'd expect to read in a credible review.

the Cass team is extraordinarily casual when it comes to amplifying potential harms.

That is quite the comment to make about a systematic review team and the reviewers.

The footnotes are a disgrace. I went into it thinking there would references for some of the blog post's more extraordinary claims but it's snipes and snark of the sort you'd expect to see on MN not a review with pretensions. Footnote 28:

Dr Cass expressed her dismay and shock at the practice of medical transition to one of us before she started this review, and recommended strongly that we read the gender critical polemic “Irreversible Damage” on the subject. She is described on the Cass review website as an expert who came in with no fixed views - we will leave the reader to draw their own conclusions.

And one of the authors is offering up their memory of a conversation as part of a serious critique and invitation to others to engage their critical faculties? No awareness that their own recollection might be subject to skew and personal cognitive biases?

It's an open whinge letter (to indulge in the writers' casual language).

We shouldn’t be encouraging anybody down a medical pathway with very serious side effects, without evidence that it is the best approach available. That is the least I would expect from any doctor to any patient in any circumstance.

God, that's a hilarious quote isn't it? That group has absolutely no self-awareness.

Yes, they're so immersed in their own ideology, that people are 'born trans' and that being 'gender diverse' requires serious physical, medical intervention, that they can't even see that they are coming from a "particular world view and set of beliefs" and that they are far from objective.

One example:
Many of the pre-pubertal gender diverse young people seen at the GID service were doing well in many or all areas of their lives, post social transition, and it was often only when puberty started that distress levels increased.

You don't even have to think very long and deeply to see why children who have socially transitioned and have been 'affirmed' in their opposite sex identity are so distressed by the onset of puberty. When a little boy, who has been encouraged to believe that if he changes his name to Emily and wears dresses and everyone pretends he is a girl, that it's possible for him to become a woman, finds his body changing at puberty and it's clear that he's becoming a man, not a woman, of course he's going to be distressed. But the fault lies with the adults who lied to him, not with the natural process that his body is going through.

Yes. Adults indulge a child’s fantasies, and the child is upset when reality shatters them. Without adult encouragement, the child would probably have lost interest and moved on to something else. It’s mind-bogglingly weird that anyone could be surprised by that.

It’s mind-bogglingly weird that anyone could be surprised by that.

And pretty astonishing coming from a paediatrician and a psychologist. I'd expect them to actually know something about child development.

I have to say I do agree with this point. Cass starts from a position that gender belief is not just a belief system and that for children to be ‘trans’ is a reasonable outcome then works from there rather than examine the legitimacy of gender ideology as a condition that needs medical treatment at all.

The Cass team do not mention any of the potential harms caused by not offering treatment, of which there are many - the development of permanent secondary sex characteristics that are not congruent with a person’s gender identity (e.g. a deepening voice, facial hair growth, breast tissue growth to name a few) can cause high levels of distress to many gender-diverse youth.

If they are claiming (as I presume they are) that they are not ideologically driven, and are giving an objective, non-partisan view, they should be able to explain what they mean by this, and give objective definitions of the terms used.

What does 'gender-diverse' mean? What is a 'gender identity'? Why makes particular sex characteristics 'congruent with' a particular 'gender identity'? Why is it important that those sex characteristics are 'congruent with' a particular 'gender identity'? Why is it better to change the body than encourage someone to accept that their body is not 'congruent with' their 'gender identity'?

To sum up: we are true believers and are willing to sterilize children (with no evidence of benefit and increasing evidence of harm) in the service of our beliefs.

The only thing that should happen following this is a fitness to practice tribunal - how can they give the best care to their patients if they are so blinkered?

Their example shows why socially transitioning children before puberty is child abuse. Boys can behave as femininely as they want, wear dresses and girls can play football. Doesn't make them the opposite sex. Adults lying to children is what has caused that distress and the failure of hcps in their positions not to acknowledge even that possibility is seriously troubling and suggests an inability to provide care without bias.

Social transitioning is not a neutral act.

This is really unimpressive and intrigued by their claim in first paragraph that Cass is the most comprehensive review 'to date' as '[1] Germany (Austria and Switzerland) are about to publish their own review, which took 7 years to complete.' Whose review is this and do they think that 'comprehensive' equates to 'took a long time to do it'?

I was intrigued that they cite '[2] MacNamara et al., 2024. An evidence-based critique of “the Cass REview” on gender-affirming care for adolescent gender dysphoria. (<a class="break-all" href="https://archive.ph/o/D7Hys/law.yale.edu/sites/default/files/documents/cass-response-7.11.24.pdf" rel="nofollow" target="_blank">Microsoft Word - Cass Response 7 11.docx (yale.edu))' the so called 'Yale Law School' criticism of Cass. I was prompted to look into MacNamara and started a thread on that just now as she (this work) is coming up a lot. Its not just rabbit holes, these holes are connected in a rabbit warren sort of way. Lots of mad rabbits in them citing each other?

Adults lying to children is what has caused that distress

This, 100000 times over.

Not read the document yet but this tweet in the chain stood out as a red flag, it's like a who's who of gender twats:

We are extremely grateful to the people who have inspired our writing, including @GidMK @RottenInDenmark @AlexAshman @Chican3ry @DadTrans and many others. As people involved in the transition from the old GiDs to the new, we're very concerned about the future.

Michael Hobbs (@RottenInDenmark) has to be one of the worst inspirations out there. He constantly misinterprets, equivocates and flat-out lies about this topic, and has a horrible mansplaining 'podcast bro' attitude too. As for Mallory Moore (@Chican3ry), I'll just say it's worth reading the Reduxx article on him.

Fascinated by Max Davie's publication record especially the article 'How I found my tribe' about his neurodiversity diagnosis.

Maybe it's different for male doctors because I don't mention my diagnosis to anyone as the stigma is so fucking huge. Managers just assume you can't do the job.

He seems to have made a nice career out of being an untouchable activist.

Former education lead for the new GOSH gender identity clinic - he's been sacked, hasn't he?

Hard agree.
It's long overdue that some of these activists masquerading as doctors saw the inside of a prison cell for their wilful mistreatment of such vulnerable children.

“As people involved in the transition from the old GiDs to the new, we're very concerned about the future.”

This is very concerning.

These are NHS workers who appear to be ideologically opposed to supporting children to be comfortable and content with their biological sex and with the body they have, and ideologically opposed to a cautious evidence-based approach to supporting children who are in distress.

I guess the Cass report in effect pointing out that these NHS workers have been placing children on a pharmaceutical and irreversible surgical intervention pathway without adequate evidence of benefits could cause them to feel defensive of their actions, position and professional reputations, and cause them to scrabble about looking for post-hoc justification for their approach to treating child patients in distress from any online activists who might offer them an appearance of cover for their actions, or help them to feel better about the way they’ve treated child patients.

The Cass recommendation is that the service to these child patients should start operating to the same standards of evidence as is expected for other patient groups. Imagine being an NHS worker objecting to children in distress being supported to the same quality and evidence standards as other patient groups.

When it comes to social transition, vague worries that an early social transition may encourage the child to be trans and therefore have less optimal outcomes, are taken at face value, rather than being interrogated for the obvious (harmful) assumption underlying them that a trans identity is somehow less desirable than a cis identity.

I'm still waiting for one of these gender ideologues to explain why sterilising children and giving them harmful medication which will make them less healthy throughout their lives and impact their sexual function is as desirable as allowing them to grow up to be adults who will probably be able to have their own children and won't have the health problems associated with taking hormone blockers and opposite sex hormones and the possible complications of having surgical procedures to alter the appearance of their genitalia.

Michael Hobbs (@RottenInDenmark) has to be one of the worst inspirations out there. He constantly misinterprets, equivocates and flat-out lies about this topic, and has a horrible mansplaining 'podcast bro' attitude too. As for Mallory Moore (@Chican3ry), I'll just say it's worth reading the Reduxx article on him.

This.

(Name changed, obviously.)

I have met Max a number of times and my impression of him is 'grumpy and often angry'. I knew of his involvement with the new gender service, and from the tone of some recent tweets of his, this development doesn't surprise me.

Benjamin Ryan has posted a long thread about this document, pointing out the bullshit: https://x.com/benryanwriter/status/1821653395096076619

In case this is more accessible for people.

https://threadreaderapp.com/thread/1821653395096076619.html

Linking in the McNamara thread.

https://www.mumsnet.com/talk/womens_rights/5138103-yale-lass-school-cass-review-meredithe-mcnamara-and-bma-etc